Our next question is about the Azure category, and if you can get SBRT in Azure? So, can
you actually break down what our Azure category is? We have a prostate cancer staging system
and that's high-risk, but can you kind of give a breakdown of what the case is?
Well, high-risk sort of says it all. High-risk means Gleason 8, 9, or 10, PSA above 20, a
large lump in the prostate that may be coming out the edge of the gland, and SBRT (stereotactic
body radiation) is a convenient new way to give beam radiation over a short time period,
usually about 10 days as opposed to 5 to 8 weeks which is the more traditional IMRT approach.
And it is possible to give SBRT to people with high-risk prostate cancer with the Azure
category. It certainly depends on the experience of the center that's giving the treatment.
So, I don't think—like with any newer type treatment—patients don't want to be in the
learning curve of the facility where you're the first one that they've ever done SBRT
treatment in. Doctors can use the same equipment that IMRT is done with where they go in and
give a smaller dose of radiation over a, you know, five, six week period, and you know,
they can just switch the dials and they can get a big dose every other day for five treatments,
a total of ten days and they're finished. The accuracy has to be very precise, and it
is quite feasible, but as though I'm repeating myself, it's important to go to a center that
has been doing that for a while and has documented experience doing it properly.
You know, we talk about centers of excellence and interviewing the doctors before you go
into treatment. For SBRT specifically, do you have a baseline of how many procedures
would need to be done by this, you know, radiation oncologist?
I mean, that's a good question. You know, the quality control question is just as important
as what type of treatment you're going to pick whether it's SBRT or brachytherapy or
proton therapy. It's always a problem. It's like picking a good plumber or a good electrician.
A lot has to do with word of mouth. If you are soliciting a center and someone is referring
them, what's the credibility of that person? Do they have experience referring, or is it
just because they had a good experience? All these things enter into the decision making
process, and there is no simple easy answer. It's — there are sometimes very reputable
academic centers, but they always have the time when they're starting these new treatments,
so all I can say is ask questions and get a consultation from multiple sources. Perhaps
primary referring physicians that have a lot of throughput and have a lot of patients going,
and they can see the outcome afterward, but there's not an easy answer for that.
So, do you think online reviews are also a good thing to look at as well?
I would certainly look at them. We all struggle to find out what's really going on in these
centers and feedback from patients that have been there is important.
So, in the same vein as radiation, there's a patient who has a doctor who says they don't
use SpaceOAR, and they're kind of wondering if this is a red flag. So can you explain
what SpaceOAR is and let us know, is it a red flag?
To me, it would be a red flag. The best doctors who are highly skilled can usually get away
without rectal burns in 95%-98% of the time. I mean they do very very well. But I mean,
who even wants to take a 2%-3% risk that you don't have to take? The SpaceOAR is now covered
by insurance, and if the doctor is skillful putting it in, it's not a big deal, and what
this does is push the rectal wall outside the radiation field so that the dreaded complication
of long-term burn to the rectal wall is avoided. This is a very exciting thing — I think
it's one thing that's made—we talked about SBRT before where you're giving large doses
of radiation quickly over a ten-day period—has made SBRT much safer, so the risk of SBRT
without SpaceOAR was probably a little bit higher chance of proctitis or rectal burns
(that's the technical name for it) and proctitis that doesn't heal is really a dreaded complication,
so a simple intervention with SpaceOAR takes that risk away, and I don't understand why
a competent physician wouldn't want to minimize the risk of proctitis as much as possible.
Yeah, I know when I first started taking helpline calls, I got my first call with someone who
had permanent radiation burns, and it was awful — the side effects of that. So, when
SpaceOAR came out, like, a year later, I was pretty excited about it, but thank you. I
think it's a very important thing for patients to pay attention to.
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